Why it’s more important than ever to prioritize adaptabilities over capabilities

By Michael Palantoni | September 13, 2022


In Hemingway’s novel The Sun Also Rises, the mercurial Mike Campbell famously answers the question “How did you go bankrupt?” by responding, “Gradually, then suddenly.”

Timeless in its observation of human behavior, Campbell’s insight applies to many technological and business shifts throughout the ages — the rise of personal computers, the internet, smartphones and beyond. Today, we see one of these gradual-to-sudden changes happening in healthcare in the transition from software and services to platforms and ecosystems. As recently as two years ago, healthcare organizations that utilized flexible technology platforms were able to transition to alternate care delivery models within days. The result was better sustainability and continuity in patient care despite a global pandemic. The healthcare landscape has forever changed. But were you able to change with it — and will you be able to tomorrow?

Healthcare’s platform moment is now, and the shift is sudden.

But first, it’s worth examining how we got here gradually.

In the software world, products and services are traditionally installed, managed, and confined to an environment that functions mostly independently and unconnected to the outside world. A healthcare organization in this world is responsible for stability, security, access, connections to other systems, and technology — making it much more difficult to be nimble in the face of change.

Over the past 20 years, this model has been mostly replaced by software as a service (SaaS). Systems are operated in a central location that makes it easier to keep products up to date, scaled, and connected — but mostly for the organization that is the principal user of that product. You may no longer have a dark basement filled with servers, but you are still relatively isolated, connecting with other entities only where your IT team elects to build bespoke integration points. Whenever changes are made, there’s additional risk to breaking those custom integrations.

In the platform world, products are designed specifically to enable interactions between other software, businesses and systems that are not just for the organization using that product. They are architected to serve their core users and enable interaction with the broader world around them. This allows others to build new features on top of this software; communicate directly and natively in the workflows of that software; or take components of a given product and use them in another product.

We’ve seen this quite a bit in our consumer lives when the food ordering app we use to order pizza delivery is interacting with dozens of other platforms to do its work — local restaurant point-of-sale systems, financial transaction processing systems, driver logistics platforms and more. We read news on apps that aggregate stories from dozens of content management platforms from publishers. We check in on financial markets via services connecting through dozens of systems to provide near-real-time transparency of the stock market. This is where ecosystems — many platforms working as an interdependent whole — come from. Healthcare is the next industry to experience this evolution.

So how does this ripple across the healthcare continuum?

Interoperability is another major catalyst for this monumental shift. “Interoperability” has traditionally been achieved by one software system spitting out a document in a format that can just barely be consumed and parsed by another system. This is transforming dramatically and moving toward a new world where EHRs are now accessing each other directly — platform to platform — to be interoperable, and athenahealth is building out teams to enable and support this interaction.

We see the same with value-based care (VBC) arrangements and payers — there is a tremendous variety of software to take claims files and data from multiple sources to compute quality measures, but new approaches are emerging where payers are providing platforms to manage the status and interactions of VBC measures in real time. This not only enhances operational efficiency by reducing the need for dozens of systems to track quality measures, but also supports better patient outcomes. Other recent integrations within athenaOne form a new type of value-based care ecosystem, enabled by direct access to payers’ platforms. We may soon see others coming to the table in similar ways — labs, health information exchanges, patient transportation services, community resource brokers, and beyond.

One of the reasons why these innovations are so important is because most health systems are just catching up with what is required by the letter of the law. Patients have more access to their own data than ever before thanks to the 21st Century Cures Act, which went into effect in 2021 and stipulates that EHRs must act as platforms by allowing other applications to gain access to patient data when requested by a patient. The law also requires that those practices allow patients to bring whatever app they want to EHR platforms (with just a few exceptions). This means that the digital patient experience is no longer directed by a medical practice, but chosen by the patient.

For practices and providers, these changes are significant

Clinicians need to be open to many entities interacting with the platforms they use. Imagine a dozen disparate patient apps accessing health data from a single practice. This means investing in or possessing a platform that manages that lift on behalf of the practice or else there’s a risk of significant IT overhead. Platform world products are designed to handle this easily, while software world products can quickly become overrun.

It’s also important to elevate the expectations of what an electronic health record or practice management system is doing to innovate. It’s incumbent on athenahealth and other solution providers to do more than build platforms; we must also actively connect as integral partners. That removes the burden of paper chasing and file downloads, a weight on the shoulders of care delivery organizations that should be enabled to focus on higher-level priorities.

Lastly, pairing this profound change in how healthcare technology systems work with today’s challenges and opportunities makes now a more important time than ever to prioritize adaptability over capabilities. The proliferation of new care models, incentive programs, condition- and patient-specific care pathways — and events like the COVID-19 pandemic — require practices to avoid stagnant software. While the future is impossible to predict exactly, platforms that can adapt to an evolving ecosystem of payers, consumer apps, care models, patient expectations, and care delivery settings will be in a much better position to serve their customers and care teams than those designed for the needs of today.

Michael Palantoni is the vice president of product management, platform and data services, at athenahealth.

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